1
|
Montera MC, Giordano A, Asperti C, Aruanno A, Barzaghi CE, Bignardi D, Borrelli P, Bommarito L, Busa M, Calafiore P, Carusi V, Cinquini M, Cortellini G, Cocchi R, D'Auria F, De Caro F, Demonte A, Di Leo E, Di Lizia M, Di Rienzo A, Fumagalli F, Kihlgren P, Lodi Rizzini F, Macchia D, Manzotti G, Marra AM, Mileto P, Mietta S, Montagni M, Nettis E, Nucera E, Peveri S, Pivetta D, Pirisi M, Ramirez GA, Rivolta F, Rizzi A, Savoia A, Pedicini A, Scarpa A, Zambito M, Zisa G, Yacoub MR. The role of skin tests with polyethylene glycol and polysorbate 80 in the vaccination campaign for COVID-19: results from an Italian multicenter survey. Eur Ann Allergy Clin Immunol 2024; 56:17-25. [PMID: 36927838 DOI: 10.23822/eurannaci.1764-1489.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Summary Background. International guidelines suggested skin tests with Polyethylene-glycol (PEG) and polysorbate 80 (PS-80), to investigate a possible hypersensitivity to these excipients either to identify subjects at risk of developing allergic reactions to Covid-19 vaccines, or in patients with suspected IgE mediated hypersensitivity reactions (HR) to the Covid-19 vaccine. The main purpose of this study was to investigate the prevalence of PEG and PS sensitization in patients with a clinical history of HR to drugs containing PEG/PS and in patients with a suspected Covid-19 vaccine immediate HR. Methods. This was a multicenter retrospective study conducted by allergists belonging to 20 Italian medical centers. Skin testing was performed in 531 patients with either a clinical history of suspected hypersensitivity reaction (HR) to drugs containing PEG and/or PS-80 (group 1:362 patient) or a suspected HR to Covid-19 vaccines (group 2: 169 patient), as suggested by the AAIITO/SIAAIC guidelines for the "management of patients at risk of allergic reactions to Covid-19 vaccines" [1]. Results. 10/362 (0.02%) had positive skin test to one or both excipients in group 1, 12/169 (7.1%) in group 2 (p less than 0.01). In group 2 HRs to Covid-19 vaccines were immediate in 10/12 of cases and anaphylaxis occurred in 4/12 of patients. Conclusions. The positivity of skin test with PEG and or PS before vaccination is extremely rare and mostly replaceable by an accurate clinical history. Sensitization to PEG and PS has to be investigated in patients with a previous immediate HR to a Covid-19 vaccine, in particular in patients with anaphylaxis.
Collapse
Affiliation(s)
- M C Montera
- University Hospital "O.O.R.R. San Giovanni di Dio and Ruggi d'Aragona", Salerno, Italy
| | - A Giordano
- UO University Hospital "O.O.R.R. San Giovanni di Dio and Ruggi d'Aragona", Salerno, Italy
| | - C Asperti
- Unit of Immunology, Rheumatology, Allergology and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - A Aruanno
- Agostino Gemelli University Hospital Foundation IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - D Bignardi
- Allergology Unit, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - P Borrelli
- SSD Dermatology, Beauregard Hospital, Valle d'Aosta, Italy
| | - L Bommarito
- Turin Local Health Authority 4, Turin, Italy
| | - M Busa
- UOS Dermatology Hospital of Mirano, Venice, Italy
| | | | - V Carusi
- Agostino Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - M Cinquini
- SSVD Allergology, Spedali Civili, Brescia, Italy
| | - G Cortellini
- SSI Allergology Romagna Health Authority, Rimini Hospital, Italy
| | - R Cocchi
- Pneumology Unit, Busto Arsizio Hospital, Varese, Italy
| | | | - F De Caro
- UO University Hospital "O.O.R.R. San Giovanni di Dio and Ruggi d'Aragona", Salerno, Italy
| | - A Demonte
- Simple Operating Unit of Allergology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - E Di Leo
- Section of Allergy and Clinical Immunology, Unit of Internal Medicine- "F. Miulli" Hospital, Acquaviva delle Fonti, Bari, Italy
| | - M Di Lizia
- UOSD. Allergology Giulianova, Teramo, Italy
| | - A Di Rienzo
- Agostino Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | | | | | - F Lodi Rizzini
- SSVD Allergology, Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences (DSCS), University of Brescia, Brescia, Italy
| | - D Macchia
- SOS Allergology Clinical Immunology, San Giovanni di Dio Hospital, Florence, Italy
| | - G Manzotti
- Allergology Clinic, Casa di Cura Palazzolo, Bergamo, Italy
| | - A M Marra
- ASST Rhodense, Rho Hospital, Milan, Italy
| | - P Mileto
- SSVD Allergology, Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences (DSCS), University of Brescia, Brescia, Italy
| | - S Mietta
- Turin Local Health Authority 4, Turin, Italy
| | | | - E Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - E Nucera
- Agostino Gemelli University Hospital Foundation IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Peveri
- ASST Bergamo Ovest, Bergamo, Italy
| | - D Pivetta
- SSVD Allergology, Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences (DSCS), University of Brescia, Brescia, Italy
| | - M Pirisi
- Division of Internal Medicine, Ospedale Maggiore della Carità, Novara, Italy
| | - G A Ramirez
- Unit of Immunology, Rheumatology, Allergology and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - F Rivolta
- UOC General Medicine, Immunology and Allergology, IRCCS Cà Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy
| | - A Rizzi
- Agostino Gemelli University Hospital Foundation IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Savoia
- Ospedale del Sacro Cuore di Gesù - Fatebenefratelli, Benevento, Italy
| | - A Pedicini
- Ospedale del Sacro Cuore di Gesù - Fatebenefratelli, Benevento, Italy
| | - A Scarpa
- UOS Dermatology Hospital of Mirano, Venice, Italy
| | - M Zambito
- Specialist Outpatient Allergy Unit, ASP 6 Palermo, Palermo, Italy
| | - G Zisa
- SS Allergology and Clinical Immunology, Maggiore della Carità Hospital, Novara, Italy
| | - M-R Yacoub
- Unit of Immunology, Rheumatology, Allergology and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| |
Collapse
|
2
|
Liccardi G, Milanese M, Bilò MB, Liccardi MV, Gargano D, Giordano A, Habetswallner F, Lo Schiavo M, Madonna F, Montera MC, Pane G, Papa A, Pedicini A, Rogliani P. Lessons from peculiar cases of anaphylaxis: why allergists should be prepared for the unexpected. Eur Ann Allergy Clin Immunol 2021; 54:99-106. [PMID: 33939345 DOI: 10.23822/eurannaci.1764-1489.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Anaphylaxis is the most severe systemic hypersensitivity reaction, it can be caused by a number of well identified triggers such as foods, drugs, stinging insects and facilitated by predisposing clinical conditions. However, sometimes anaphylaxis shows up with uncommon or peculiar characteristics which could delay diagnosis and therapeutic treatment. In this report we aimed to describe less accounted / difficult-to-approach shapes of anaphylaxis to facilitate clinicians to suspect these severe reactions even in uncommon conditions. We choose to present data on anaphylaxis regarding simulation, mode of exposure to sensitizing agents, pregnancy, exposure to animals, intimate behaviour, psychological stress and other situations.
Collapse
Affiliation(s)
- G Liccardi
- Department of Experimental Medicine, Postgraduate School of Respiratory Medicine, Tor Vergata University of Rome, Rome, Italy
| | - M Milanese
- Division of Pulmonology, S. Corona Hospital, Pietra Ligure, Italy
| | - M B Bilò
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti, Ancona, Italy
| | | | - D Gargano
- Allergy Unit, High Speciality San Giuseppe Moscati Hospital, Avellino, Italy
| | - A Giordano
- Postgraduate School of Internal Medicine, University of Salerno, Salerno, Italy
| | - F Habetswallner
- Division of Neurophysiology A. Cardarelli Hospital, Naples, Italy
| | - M Lo Schiavo
- Allergy and Clinical Immunology, G. Fucito Hospital and University Hospital, Salerno, Italy
| | - F Madonna
- Allergy Unit, ASL (Sanitary District n°12), Caserta, Italy
| | - M C Montera
- Allergy and Clinical Immunology, G. Fucito Hospital and University Hospital, Salerno, Italy
| | - G Pane
- Department of Experimental Medicine, Unit of Respiratory Medicine, Tor Vergata University of Rome, Rome, Italy
| | - A Papa
- ASL (Sanitary District), Avellino, Italy
| | - A Pedicini
- Unit of Allergology, Division of Internal Medicine, Fatebenefratelli Hospital, Benevento, Italy
| | - P Rogliani
- Department of Experimental Medicine, Postgraduate School of Respiratory Medicine, Tor Vergata University of Rome, Rome, Italy.,Department of Experimental Medicine, Unit of Respiratory Medicine, Tor Vergata University of Rome, Rome, Italy
| |
Collapse
|
3
|
Liccardi G, Calzetta L, Milanese M, Bilò MB, Liccardi MV, Baiardini I, Gargano D, Lo Schiavo M, Madonna F, Montera MC, Papa A, Pedicini A, Habetswallner F, Giordano A, Rogliani P. Can placebo challenge test (inducing a "nocebo effect") be a suitable model to assess stress-induced bronchial obstruction? Suggestions from the multidisciplinary Working Groups "Stress-Asthma" and "AAIITO Regione Campania". Eur Ann Allergy Clin Immunol 2021; 53:284-287. [PMID: 33728834 DOI: 10.23822/eurannaci.1764-1489.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- G Liccardi
- Department of Experimental Medicine, Postgraduate School of Respiratory Medicine, University of Rome Tor Vergata, Rome, Italy
| | - L Calzetta
- Department of Experimental Medicine, Postgraduate School of Respiratory Medicine, University of Rome Tor Vergata, Rome, Italy.,Department of Experimental Medicine, Unit of Respiratory Medicine, University of Rome Tor Vergata, Rome, Italy
| | - M Milanese
- Division of Pulmonology, S. Corona Hospital, Pietra Ligure, Savona, Italy
| | - M B Bilò
- Department of Internal Medicine, Allergy Unit, University Hospital Ospedali Riuniti - Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | | | - I Baiardini
- Department of Biomedical Science, Humanitas University, Milan, Italy
| | - D Gargano
- High Speciality San Giuseppe Moscati Hospital, Allergy Unit, Avellino, Italy
| | - M Lo Schiavo
- Departiment of Allergy and Clinical Immunology, G. Fucito Hospital and University Hospital, Salerno, Italy
| | - F Madonna
- ASL (Sanitary District n. 12), Allergy Unit, Caserta, Italy
| | - M C Montera
- Departiment of Allergy and Clinical Immunology, G. Fucito Hospital and University Hospital, Salerno, Italy
| | - A Papa
- ASL (Sanitary District), Avellino, Italy
| | - A Pedicini
- Division of Internal Medicine, Unit of Allergology, Fatebenefratelli Hospital, Benevento, Italy
| | - F Habetswallner
- Division of Neurophysiology, A. Cardarelli Hospital, Naples, Italy
| | - A Giordano
- Postgraduate School of Internal Medicine, University of Salerno, Salerno, Italy
| | - P Rogliani
- Department of Experimental Medicine, Postgraduate School of Respiratory Medicine, University of Rome Tor Vergata, Rome, Italy.,Department of Experimental Medicine, Unit of Respiratory Medicine, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
4
|
Platzgummer S, Bizzaro N, Bilò MB, Pravettoni V, Cecchi L, Sargentini V, Caponi L, Visentini D, Brusca I, Pesce G, Bagnasco M, Antico A, Montera MC, Quercia O, Musarra A, Bonazza L, Borrelli P, Cortellini G, Polillo BR, Valenti B, Zedda MT, Asero R, Villalta D. Recommendations for the Use of Tryptase in the Diagnosis of Anaphylaxis and Clonal Mastcell Disorders. Eur Ann Allergy Clin Immunol 2020; 52:51-61. [PMID: 31994369 DOI: 10.23822/eurannaci.1764-1489.133] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Tryptase is a serin-protease produced and released by mast cells after IgE-mediated or non-IgE mediated stimuli. We here review the various aspects related to the molecular characteristics of the enzyme and its biological effects, the genetic basis of its production and the release kinetics. Recommendations for the clinical use of tryptase measurement developed by a task force of Società Italiana di Patologia Clinica e Medicina di Laboratorio and Associazione Allergologi Immunologi Italiani Territoriali e Ospedalieri are given on the best procedure for a correct definition of the reference values in relation to the inter-individual variability and to the correct determination of tryptase in blood and other biological liquids, in the diagnosis of anaphylaxis (from drugs, food, insect sting, or idiophatic), death from anaphylaxis (post mortem assessment) and cutaneous or clonal mastcell disorders.
Collapse
Affiliation(s)
- S Platzgummer
- Laboratorio di Patologia Clinica, Ospedale Franz Tappeiner, Merano, Bolzano
| | - N Bizzaro
- Laboratorio di Patologia Clinica, Ospedale San Antonio, Tolmezzo, Azienda Sanitaria Universitaria Integrata, Udine
| | - M B Bilò
- Unità di Allergologia, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - V Pravettoni
- Dipartimento di Medicina Generale, Immunologia e Allergologia, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milano
| | - L Cecchi
- SOS Allergologia e Immunologia Prato, USL Toscana Centro, Prato
| | - V Sargentini
- UOC Patologia Clinica, Ospedale San Filippo Neri ASL Roma 1, Roma
| | - L Caponi
- Laboratorio di Patologia Clinica, Azienda Ospedaliero-Universitaria Pisana, Università di Pisa, Pisa
| | - D Visentini
- SOS Laboratorio di Immunopatologia e Allergologia, Azienda Sanitaria Universitaria Integrata, Udine
| | - I Brusca
- UOC Patologia Clinica, Ospedale Buccheri La Ferla Fatebenefratelli, Palermo
| | - G Pesce
- Laboratorio Diagnostico di Autoimmunologia IRCCS, Ospedale Policlinico S. Martino, Università di Genova, Dipartimento di Medicina Interna e Specialità mediche (DIMI), Genova
| | - M Bagnasco
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università degli studi di Genova
| | - A Antico
- UOC Servizio Medicina di Laboratorio, AULSS 7 Regione Veneto, Santorso, Vicenza
| | - M C Montera
- Allergologia e Immunologia Clinica, Ospedale G. Fuscito, Mercato S. Severino, Az. Ospedaliero-Universitaria Ruggi D'Aragona, Salerno
| | - O Quercia
- S.S. Interdipartimentale di Allergologia, Ospedale di Faenza, Ravenna
| | - A Musarra
- Servizio di Allergologia, Casa della Salute di Scilla, Scilla, Reggio Calabria
| | - L Bonazza
- Divisione di Pneumologia, Ospedale di Bolzano
| | - P Borrelli
- Ambulatorio di Allergologia e Immunologia Clinica, Ospedale Beauregard, Aosta
| | | | - B R Polillo
- UOS Allergologia, PTP Nuovo Regina Margherita, Roma
| | - B Valenti
- Allergologia e Pneumologia, PTA Biondo, ASP, Palermo
| | - M T Zedda
- Libero professionista in Allergologia, Cagliari
| | - R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milano
| | - D Villalta
- SSD Immunologia e Allergologia, Presidio Ospedaliero S. Maria degli Angeli, Pordenone
| |
Collapse
|
5
|
Cappuccio A, Bugliaro F, Caimmi SME, Caldarelli V, Caminiti L, D'Auria E, di Palmo E, Duse M, Fiocchi AG, Gesualdo F, Kantar A, Lombardi E, Lucania A, Marchiani M, Marini MG, Marseglia G, Montera MC, Novembre EM, Pellegrini G, Piacentini G, Policreti A, Santamaria F. Consensus communication strategies to improve doctor-patient relationship in paediatric severe asthma. Ital J Pediatr 2019; 45:31. [PMID: 30832703 PMCID: PMC6399976 DOI: 10.1186/s13052-019-0623-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/25/2019] [Indexed: 11/13/2022] Open
Abstract
Background Asthma is a chronic inflammatory disease that is very common among youth worldwide. The burden of this illness is very high not only considering financial costs but also on emotional and social functioning. Guidelines and many researches recommend to develop a good communication between physicians and children/caregiver and their parents. Nevertheless, a previous Italian project showed some criticalities in paediatric severe asthma management. The consensus gathered together experts in paediatric asthma management, experts in narrative medicine and patient associations with the aim of identify simple recommendation to improve communication strategies. Methods Participants to the consensus received the results of the project and a selection of narratives two weeks before the meeting. The meeting was structured in plenary session and in three working groups discussing respectively about communication strategies with children, adolescents and parents. The task of each working group was to identify the most effective (DO) and least effective practices (DON’ T) for 5 phases of the visit: welcome, comprehension of the context, emotions management, duration and end of the visit and endurance of the relationship. Results Participants agreed that good relationships translate into positive outcomes and reached consensus on communication strategies to implement in the different phase of relationships. Conclusions The future challenges identified by the participants are the dissemination of this Consensus document and the implementation of effective communication strategies to improve the management of pediatric asthma.
Collapse
Affiliation(s)
| | | | | | | | - Valeria Caldarelli
- Pediatric Clinic, Azienda Ospedaliera Santa Maria Nuova, Reggio Emilia, Italy
| | - Lucia Caminiti
- Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy
| | - Enza D'Auria
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Emanuela di Palmo
- Pediatric Clinic, Ospedale S. Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Marzia Duse
- Department of Pediatrics and child Neuropsychiatry, University Sapienza, Rome, Italy
| | | | | | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi University and Research Hospitals, Ponte San Pietro-Bergamo, Italy
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, "Anna Meyer" Pediatric University Hospital, Florence, Italy
| | - Anna Lucania
- Pediatria ospedale dei bambini arnas civico, Palermo, Italy
| | | | - Maria Giulia Marini
- Healthcare Area, ISTUD Foundation, Via Vittor Pisani 28, 20128, Milan, Italy
| | - Gianluigi Marseglia
- Pediatric Clinic of the University of Pavia - IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Maria Carmela Montera
- Department. of Medicine, Unit of Allergology and Clinic Immunology, AOU S.Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | | - Guido Pellegrini
- U.O. of Pediatric and Neonatology, Hospital City of Sesto San Giovanni (MI), ASST Nord Milano, Milan, Italy
| | | | | | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| |
Collapse
|